OKOJ, Volume 10, No. 2

Adult scoliosis is a curvature in the spine that becomes symptomatic or develops during adulthood. As opposed to idiopathic adolescent scoliosis, adult scoliosis is frequently associated with back pain in addition to neurologic claudication or radiculopathy from stenosis. Patients may also have significant functional limitation from sagittal or coronal imbalance. Nonsurgical treatment should be the first approach in managing these patients, and may include physical therapy, activity modification, and epidural steroid injections. Surgery is indicated for patients who are refractory to nonsurgical management and/or have severe debilitation. Complications of surgical intervention include neurologic deficit, significant loss of correction, deep infection, medical complications, and even death. Newer techniques in fixation, approach, anesthesia, improved perioperative care, and use of neuromonitoring have decreased these overall risks.

Although entrapment of the suprascapular nerve is an uncommon source of shoulder pain, proper diagnosis and treatment are critical to maintain function, reduce or eliminate pain, and prevent chronic atrophy of the supraspinatus and infraspinatus. In this article, we present an arthroscopic technique for suprascapular nerve decompression at the spinoglenoid notch or suprascapular notch, either through the subacromial space or glenohumeral joint. These methods allow for facile decompression of the suprascapular nerve and direct visualization of the medial neck of the glenoid to avoid complications from iatrogenic nerve injury related to aggressive dissection of the medial capsule.

In general, external fixation can be used in pediatric patients just as it would be used in adult patients. The most common clinical scenarios would be deformity correction, reconstruction following trauma, and contracture correction. However, several differences make the use of external fixation in children unique, including the physical presence of the physis, the potential for growth, and the smaller body size. Although these factors create a perception that the application of external fixation can be difficult to perform in a child, this is not necessarily true. This article outlines philosophies and techniques to help make external fixation of a pediatric patient a positive experience for both the surgeon and the patient.

Retrograde intramedullary nailing is an effective technique for stabilizing subtalar and ankle joint fusion, which is indicated as a salvage procedure for severe symptomatic degenerative and posttraumatic conditions of the hindfoot. This article reviews and illustrates the surgical technique for retrograde intramedullary nailing in tibiotalocalcaneal fusion, as well as the surgical indications and contraindications for and alternatives to this procedure. Practical pearls and pitfalls associated with hindfoot nails, based on extensive clinical experience, are also described.

Keywords:

tibiotalocalcaneal arthrodesis

TTC arthrodesis

hindfoot arthodesis

hindfoor fusion

intramedullary nail

intramedullary fixation

retrograde nailing

Subspecialty:

Foot and Ankle

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